title: A speedy recovery: amphetamines and other therapeutics that might impact the recovery from brain injury.
abstract: OBJECTIVE
  Traumatic brain injury is the leading cause of death in young patients and stroke is the leading cause of major disability in elderly patients. Both injuries are often followed by cerebral plasticity changes and increased intracerebral pressure (ICP). Aim of the review is to present current knowledge about amphetamines and other therapeutics concerning the recovery of brain injury based on contemporary findings.
  
  
  RESULTS
  On the one hand beneficial effects for cognitive and physical outcome after brain injury by coupling amphetamine with physical therapy could be demonstrated; on the other hand its efficacy was shown in only two out of 10 clinical trials.
  
  
  CONCLUSIONS
  Impairment after brain injury is reduced if adequate early treatment is established. On the basis of current findings amphetamine after brain injury cannot be recommended. In patients with an increased ICP the maintenance of an adequate cerebral perfusion pressure is required. In patients with increased ICP under controlled ventilation, the combination of ketamine with, for example, a short-acting benzodiazepine and opioid or methohexital is equally well tolerated. Ketamine decreases ICP without lowering blood pressure and cerebral perfusion pressure. Its neuroprotective property might reduce the exacerbation of brain injury following N-methyl-D-aspartate-receptor activation, neuronal apoptosis and systemic inflammatory responses.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité - University Medicine Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Harbeck-Seu
authors.forename: Irene
authors.initials: I
authors.lastname: Brunk
authors.forename: Thomas
authors.initials: T
authors.lastname: Platz
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
mesh_terms: D000662:Amphetamines / Q000494:pharmacology / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation; D000697:Central Nervous System Stimulants / Q000494:pharmacology / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000628:therapy; D004632:Emergency Medical Services; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology; D010360:Patient Transfer; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D020521:Stroke / Q000188:drug therapy* / Q000523:psychology; D000071939:Stroke Rehabilitation
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants